Are Your Prices Optimized For 2024?

The most common pricing methodology is % of Medicare - but is that really the best way? Medicare is traditionally a lower fee schedule, meaning you are likely taking a lower fee schedule and doing a higher markup than is necessary. Plus, some commercial payers may have rates that are higher than 150% or 200% of your Medicare rate, which means that you might be leaving money on the table by setting prices at that fixed rate.

Contract and reimbursement data is one of the only proprietary factors that differentiate payers across networks, making it extremely valuable.

The payer contract determines what providers are in-network with that insurance carrier, and the reimbursement rate determines what they are paying out which drives operating margins.

Once you have compiled your payer contracts, put them to work. Understanding what they entail can make a difference in all aspects of your practice, from accounts receivable to patient satisfaction. Plus, recognizing the good and the bad in your contracts will empower you to make more informed decisions, building a strong foundation for success at your practice.

Modeling Proposals to Understand Impact

Now that you have compiled your contracts and fee schedules, you’ll want to know how they are going to affect your revenue. Modeling can play an important role in knowing what you have signed up for, but often goes undone. At CodeToolz, our Contract Analyzer (below) compares current fee schedules to a proposal or other scenario. It also helps you to know when a fee schedule will not benefit you so you can push back on the payer.

When considering a model to apply to your contracts, it’s helpful to know what makes a model successful. We recommend considering the 3 A’s:

1. Accuracy: Ensure that your model produces correct values and that you are grouping codes correctly.
2. Automation: Your model should not be driven on manual, “hard-coded” inputs. Instead, revenue impact should dynamically shift based on automated inputs.
3. Actionable: A successful model should generate valuable insights that show you what needs to be addressed.

Making Use of Payer Contracts and Fee Schedules

You’ve been diligent at collecting payer contracts and fee schedules, finding reps, analyzing the good and recognizing the bad, so what is next? To start, you can begin to prepare for negotiations now that you understand your current rates.

In addition, you can use this knowledge to help communicate estimated costs more effectively to your patients which will help to improve collections. You can also use your contracts to help identify when your payer is not paying you per your contract and work to reduce administrative denials (timely filing). Lastly, you should use your contracts to improve your net revenue reporting.

Summary

Knowing how your #payercontracts are constructed, what your baselines are, how your #feeschedule has evolved and what all of that information might mean for your #medicalpractice can be significant when considering contract analysis. For instance, we know that a lot of contracts are based on Medicare and sometimes there are fixed Medicare years.

However, oftentimes your fee schedule will get updated shortly after Medicare pushes a new fee schedule. If your contacts are structured so that your reimbursement is a percentage of current year, you may not actually know that your contracted rates are changing, just because Medicare is changing.

We Take Your Payer Contracting From Burden To Competitive Advantage

• Contract Relations: We know how payers work. We have negotiated contracts for decades with the majority of national payers including federal programs.
• Contract Evaluation: We review your payer contracts and fees to create a unique written analysis giving you our seasoned opinion on contract language, requirements, payer contacts and fee analysis.
• Contract Fee Analysis: We focus on your bottom line, comparing all your contract rates and developing an average acceptable rate.
• Contract Negotiations: We bring 30+ years of successful negotiations with payers. After our review, if there is potential for renegotiation, we will draft all correspondence and be involved with the entire negotiation process.

The Physician's Advocate in Payer Contracting

Our roots in payer contracting run deep, making CodeToolz one of the most effective payer contracting and reimbursement firms in the country.

Once our team has a clear understanding of what your payer contract contains, we identify strengths, weaknesses, and improvement opportunities and review them with you.

Let the experts at CodeToolz take your contracting efforts from burden to competitive advantage. The bottom line is that in negotiations, knowledge is power and planning is essential. Contact Us Today! (512) 787-1852

Schedule Your Fee Consultation / Demo here.